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154 5.2 Common Nutritional Problems in Preschool Children
to helping families decide how to change the way ●● enamel hypoplasia and delayed appearance of
they manage mealtimes and feeding children with teeth
feeding difficulties. Before referral, a child should
have been seen by a doctor and any relevant ●● deformity of spine (kyphoscoliosis) and pelvis in
investigations done. longstanding cases.
Feeding assessments may be done by one or two Vitamin D deficiency can only be diagnosed by a
trained health professionals in the home or within blood test and these are not done routinely. Risk
a specialist clinic. The combination of specialized factors that make vitamin D deficiency more likely
healthcare professionals that see patients within a include:
clinic usually includes:
●● Asian, African and Middle-Eastern ethnic origin
●● community paediatrician/paediatric ●● prolonged exclusive breastfeeding with late
gastroe nterologist
weaning
●● clinical psychologist ●● not taking the recommended daily supplement
●● paediatric dietitian of vitamin D (see Chapter 5.1, page 136)
●● limited options for being outside
●● speech and language therapist. ●● excess use of sunscreen which prevents
Vitamin D Deficiency and Rickets cutaneous synthesis of vitamin D.
The main source of vitamin D is not food but that Once diagnosed, vitamin D deficiency or rickets is
made in the skin when outside in sunlight (see treated with high doses of vitamin D until
Chapter 1.1 page 6). Current indoor lifestyles do symptoms resolve.
not always allow adequate skin synthesis even in
summer for under-fives. Acknowledgements
Although national statistics are not being With thanks to Dr Gill Harris, Clinical
collected there are reports in the literature that Psychologist, University of Birmingham and
vitamin D deficiency and rickets in the UK are Birmingham Children’s Hospital, Birmingham.
increasing (Ahmed et al. 2011). Deficiency not only
affects growth and long-term bone health, but has References and further reading
also been implicated in certain forms of cancer,
cardiovascular disease, tuberculosis, multiple Ahmed SF, Franey C, McDevitt H, et al. (2011) Recent
sclerosis and type 1 and 2 diabetes. trends and clinical features of childhood vitamin
D deficiency presenting to a children’s hospital in
The specific effects of vitamin D deficiency Glasgow. Archives of Disease in Childhood 96:
include: 694–696.
●● decreased calcium absorption from diet, low Booth IW and Aubett MA (1997) Iron deficiency in
plasma calcium, increased plasma bone alkaline infancy and early childhood. Archives of Disease in
phosphatase activity (commonly measured in Childhood 76: 549–554.
blood tests)
Cooke L (2004) The development and modification of
●● raised parathyroid hormone concentration to children’s eating habits. Nutrition Bulletin 29:
mobilize calcium from bone 31–35.
●● rickets: swelling of rib junctions giving a Crowley E, Williams L, Roberts T, Jones P and
characteristic lumpy appearance (‘rachitic Dunstan R (2008) Evidence for a role of cow’s milk
rosary’); ‘bow legs’ in weight-bearing children; consumption in chronic functional constipation
swelling over the ends of long bones (e.g. wrist) in children: systematic review of the literature
from 1980 to 2006. Nutrition and Dietetics 65:
29–33.
